Tag - prescriptions

1
Statin Discontinuation in Hospice Patients
2
Safe Medication Practices

Statin Discontinuation in Hospice Patients

Hospice prescribers and pharmacists have long approached statins as appropriate for discontinuation in their patients who have no active cardiovascular disease since preventative or prophylaxis medications, as well as medications with long-term therapeutic outcomes, are not considered part of palliative care.  With the benefits of statin discontinuation ranging from decreasing pill burden to preventing myopathy, from cost-savings to fewer drug-drug interactions, it has become a common practice.  However, many hospice prescribers still overlook the potential benefits of statin discontinuation such that they do not always consider it in a timely manner after admission to hospice.

When the hospice team admits a patient with no known cardiovascular disease who is on a statin, it is helpful to remind new hospice prescribers of research demonstrating that the discontinuation of statins in this population does not alter mortality rates within 60 days of discontinuation or alter the median time to death.  Similarly, discontinuation does not appear to affect rates of cardiovascular events but may actually provide improvements in quality of life.  Research findings also imply that it is possible that statin deprescribing may lead to a reduction in the number of non-statin prescriptions required, perhaps due to fewer adverse effects requiring treatment for patient comfort.  It is prudent to consider the risks of continuation of any medication that no longer provides benefit, especially when dysphagia is present.

Of course, discussions about discontinuing any therapy should occur in the context of shared decision making, especially in the case of statins as research indicates that neither continuation nor discontinuation is clearly superior.  Furthermore, the data surrounding the topic of stopping statins in late-stage terminal patients serves as a reminder of the importance of utilizing patient-centered ongoing medication therapy reviews as an opportunity to continually assess the risk versus benefit of all components of a hospice patient’s medication regimen.

 

References:

Kutner, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA. 2015 May;175(5):691-700  https://www.ncbi.nlm.nih.gov/pubmed/25798575

Holmes H. & Todd A. Evidence-based deprescribing of statins in patients with advanced illness. JAMA. 2015 May;175(5):701-702  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420700/

Voelker R. Statin use may stop when illness is terminal, study says. JAMA. 2014 Jul 16;312(3):221

Safe Medication Practices

The Institute for Safe Medication Practices (ISMP) has long recognized the frequency of mix-ups resulting from the non-standardization of units utilized in measuring volume of oral liquid medications.  Since 2009, ISMP has strongly encouraged all practitioners to solely utilize the metric system for measuring oral liquid doses.

The National Council for Prescription Drug Programs (NCPDP) supports the use of the milliliter (mL) as the standard unit of liquid measure for prescription oral liquid medications.  In addition to encouraging the use of the milliliter unit alone for such products, NCPDP stresses that dose amounts should always include leading zeros before the decimal point when the amount is less than one milliliter and should not include trailing zeros after a decimal point.  For instance, directions for eight tenths of a milliliter should be written as 0.8 mL and never .8 mL where the decimal point can be overlooked and the dose misinterpreted as 8 mL.  Similarly, utilize 2 mL rather than 2.0 mL which can be confused as 20 mL.  Altogether avoid the use of the teaspoon or other non-metric measurements for all patient instructions.

Always ensure that patients have a measuring device marked clearly in milliliters only to prevent errors.  For further patient safety, ISMP recommends that patients and/or caregivers be coached on use and cleaning of oral liquid measuring devices, utilizing the “teach back” approach to ascertain whether or not training is understood.

References:

  1. NCPDP recommendations and guidance for standardizing the dosing designations on prescription container labels of oral liquid medications. http://www.ncpdp.org/Education/Whitepaper. March 2014
  2. ISMP 2014-15 targeted medication safety best practices for hospitals, best practice 5. ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.

Copyright © 2014. Created by Meks. Powered by WordPress.